Organization
RENEW ADDICTION TREATMENT CENTER
Active
Parent organization
ADAPT
Other names
Behavioral Health Professionals, Renew ATC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADAPT
Authorized official
MRS. AMBER SISCO (MANAGING MEMBER)
(606) 653-1505
Entity
Organization
Contact information
Practice address
400 VENTERS LN STE 100, PIKEVILLE, KY 41501-3016
(606) 653-1505
Mailing address
PO BOX 1285, PIKEVILLE, KY 41502-1285
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
740318
KY
207RA0401X
Addiction Medicine (Internal Medicine) Physician
740318
KY
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
740318
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
740318
STATE FACILITY LICENSE- SPECIAL HEALTH CLINIC
KY
Enumeration date
12/08/2014
Last updated
09/09/2022
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